Healthcare Provider Details

I. General information

NPI: 1881904761
Provider Name (Legal Business Name): KRISTI KATHRYN BLAKEMORE M. ED, BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 N PORTLAND AVE
OKLAHOMA CITY OK
73112-2077
US

IV. Provider business mailing address

1315 N BROAD ST
GUTHRIE OK
73044-1828
US

V. Phone/Fax

Practice location:
  • Phone: 405-943-7500
  • Fax:
Mailing address:
  • Phone: 405-831-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number303586
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: